The PBM should be able to confirm the specifics of the reference drug for each multi-source brand, such as how the lowest cost interchangeable price is established by the PBM.
Long-term
Plan sponsors must understand the cost implications of doing nothing, explained Poirier. They must examine the employer and employee cost sharing strategy and find the absolute value or trend rate that will cause enough concern to require action. Are costs allocated to employees as a contribution or deductible? Are co-payments applied only where an employee has the ability to make a choice?
Next, plan sponsors should determine what’s covered now and at what level. With a wide open formulary, when will you need to manage what’s covered? In terms of the choice of drugs, they should also develop a rational, defensible answer for why certain drugs are/are not covered.
Finally, know what PBM support you can access for better management. “Plan sponsors should prepare to manage your vendor services to support management of the largest portion of your spend (not just your admin rates),” she said, including:
• pricing file management and transparency,
• audit of compliance with plan terms,
• support for better practice clinical management and member support
• support for better channel management.
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